Medical Tourism Blog, Surgical Tourism Blog, Overseas Medical Travel Blog - Healthbase

New England leads, the South rated worst on health care scorecard

healthbase — Thu, 22 Oct 2009 03:36:27 +0000

Vermont leads the nation in the delivery of its health care, while Mississippi is rated the worst, according to a non-partisan study that compares all 50 states and the District of Columbia.

Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire ranked 1 to 5 in 38 indicators of health care.

At the bottom were Mississippi, along with Oklahoma, Louisiana, Arkansas, Nevada and Texas.

The Commonwealth Fund Commission’s “Scorecard on Health System Performance,” rated the states on access, quality, costs and health outcomes in a follow up to their 2007 report.

Overall, the states which did best on the Commonwealth scorecard were in New England and the upper Midwest, and the worst states were in the South.

Vermont, with only 640,000 residents, has nearly universal health care coverage with 93 percent insured. Its innovative “Blue Print for Health” focuses on prevention of chronic diseases.

“We’re small. There are 19 cities larger than the state of Vermont,” said Susan Besio, director for health care reform and Medicaid for Vermont.

“But I believe there is something unique about Vermont in terms of its culture,” she told ABCNews.com. “We want to take care of each other and we are a healthy state.”

In Mississippi, however, about 20 percent are uninsured despite having some of the highest rates of hypertension, diabetes and asthma.

According to the report, only 35.7 percent of adults 50 or over in Mississippi receive recommended screening and preventive care.

“When you compare Mississippi on almost any socio-economic profile, we are a struggling population that has a large percentage of low-income individuals, high unemployment rates, low rate of education,” said Robert Pugh, director of the Mississippi Primary Health Care Association.

The scorecard “paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs,” according to co-author Cathy Schoen, who is senior vice president of the commission.

“Where you live matters for access, quality of care and whether you live a long and healthy life. These wide and persistent gaps among states highlight the need for national reforms and federal action to support states.”

For example, 32 percent of working-age adults in Texas are uninsured, compared to only 7 percent in Massachusetts in the most recent survey.

“It’s very hard to have a high performing health care system and hospitals that do well for everyone if you have a high rate of uninsured in the state,” said Schoen.

In 1999-00, there were only two states with 23 percent or more of adults uninsured. But by 2007-2008 there were nine.

Children fared much better, due in large part to the Children’s Health Insurance Program (CHIP) under Medicaid. The number of states with 16 percent or more of children uninsured dropped from nine to three during the same time period.

Other findings of the report were that in a, costs rose and quality improved in areas where outcomes were reported to the public.

Vermont’s ‘Blue Print For Health’ A Model

The Green Mountain state was cited for its model “Blue Print” program. Launched by Republican Gov. Jim Douglas, it covers everything from teaching children healthy eating to helping seniors stay in their homes rather than going to costly nursing homes.

“You betcha, I feel good about the reforms we put in place,” Douglas told ABCNews.com. “It’s centered on quality and containing costs. Care shouldn’t start in the emergency room.”

All Vermonters are encouraged to have yearly exams and adults are notified when they are due for check-ups.

Douglas talks to children about “getting off the couch” and set an example just this week by joining elementary students on a walk to school.

With the second oldest population in the nation, Vermont subsizes care for seniors and the disabled to defray the costs of home care. Nursing home beds were reduced by 200 last year.

In one pilot program, electronic medical records can avert expensive tests like MRIs and x-rays. One emergency room doctor seeing a woman with stomach pains discovered in her online medication history that she had not filled her prescription for ulcer medicine.

“It takes time and so a lot of the fruits come from years of work and planning and cooperation,” said Douglas.

Health Care Affects a State’s Economy

But Mississippi, with the highest infant mortality and low birth rates in the nation, makes access to these Medicaid programs more difficult, according to Roy Mitchell, director of the Mississippi Health Advocacy Program (MHAP).

“I am not at all surprised we were 51st on the list,” he told ABCNews.com. “We are last on several health indicators. Our policy makers work hard at being last.”

Despite one of the highest matches of federal to state dollars in Medicaid funding, the state mandates “face-to-face” eligibility, requiring all new applicants and those reapplying for benefits to come in for an interview.

“As a direct result, 65,000 children have fallen off the rolls,” Mitchell said.

“Mississippi does virtually no outreach at all. They don’t publish where these face to face stations are and what times,” he said. “It’s a bureaucratic maze even to find out where to go. And when they get there they don’t have a certain document.”

Of those, about 77 percent would be eligible, he said. “It’s touted as fraud prevention.”

These disparities between the highest and lowest ranked states could be alleviated with national reform, according to Commonwealth.

The report emphasizes the need for insurance reform that rewards good outcomes, payment reform with an emphasis on prevention and advanced information systems that travel with the patient from physician to physician, saving time, money and preventing errors.

“What the scorecard is showing is that we have a system under stress, no matter where we live,” said co-author Schoen. “The costs are rising more than people’s incomes. We need to act.”

Schoen said she has hope for reform. “There is real leadership and people are taking reform seriously.”

Source: ABC News

Log on to Healthbase to learn about medical tourism or to get a FREE quote for any surgery in the United States or abroad.

Like it? Share it or save it!!

Facing aging without health insurance

healthbase — Thu, 01 Oct 2009 08:50:40 +0000

We all know the facts and the figures. About 46 to 47 million Americans are uninsured and with the economic recession not yet over, several more are expected to join the ranks.

The Congress is still debating over a national health care reform which no one knows will lead to what consequences. So, given the current state of affairs, the big question still looms – Who takes care of you when something major comes up? Or, worse yet, What happens if you are aging, start having health problems and no insurance wants to cover you even if you are willing to purchase the most expensive catastrophic policy?

NPR recently ran the story of a 58-year old uninsured American who landed himself into exactly this sort of a situation. Read on…

Fernando Arriola spends his days keeping track of four or five construction projects, and his nights praying for good health. The New Orleans home builder is one of the 46 million people in this country who don’t have health insurance.

Four years ago Arriola, 58, bought a friend’s contracting business, just as New Orleans was starting to rebuild after Hurricane Katrina. He named it New Beginnings Enterprises.

“It was a new beginning for me; it was a new beginning for the city; it was a new beginning for a lot of people we were working with,” he says.

And business has been good. He does mostly residential work, like the quaint mother-in-law cottage in the Garden District where his crew is laying tile and putting on the finishing touches.

Making A Living, But Not Enough For Insurance

Arriola makes about $50,000 a year and says he enjoys working for himself. But what he’s missing is the comprehensive health coverage he had at his former job as a sales manager.

Ever since he’s been self-employed, Arriola has been on a health insurance roller coaster. Initially, he bought a standard policy with a $1,000 deductible to cover his family. Then, when business slowed down and money got tight, he decided to temporarily drop the coverage. When he tried to reinstate it, he could only afford a catastrophic plan.

“I was paying $900 a month for a $5,000 deductible that would cover nothing until I hit that $5,000. So I was paying in essence $15,000 before I had one penny covered. And that was too expensive,” Arriola says.

So he dropped that coverage, only to have second thoughts. And when he tried to get it back, he was denied even the expensive catastrophic policy. Arriola doesn’t know exactly why, but he acknowledges that he and his wife both have high blood pressure and are approaching 60.

“Insurance is nothing more than just a business. And they try to limit their liabilities. So where there’s an older person, they don’t want to cover it,” he says.

Aging Without Coverage

Maria Arriola doesn’t think it’s fair that after years of paying for coverage and not having many claims, now, when they are starting to have health problems, they can’t get insurance.

“There’s nothing you can do about that. As you get older things don’t work so well, so…” she says.

The Arriolas did buy a policy for their two daughters, ages 22 and 16. But Fernando and Maria are uninsured. They pay for doctor visits and prescriptions out of pocket.

If something major comes up, Arriola says he would leave the country for medical services. Arriola is a naturalized citizen and has lived in New Orleans since 1970. But last year, he traveled to his native Guatemala for arthroscopic knee surgery. It cost him less than $1,000.

“Over here [it] would cost me thousands. They have just as good of doctors as they have over here. Most of them graduated from here,” he says.

Not Waiting For Congress To Fix

As for the debate on Capitol Hill over health care reform, Arriola takes a businessman’s approach to the issue: Open up the marketplace, he says, and create a national playing field so consumers will have more options.

But he does not have faith that Congress will come up with a fix because of partisan politics. So, in the meantime, he’s working to do something locally as a member of the board of directors for the New Orleans Faith and Health Alliance. The group is trying to start a health clinic in unused classroom space at a midcity church. Patients would pay based on their income.

“The purpose is to be able to provide the working uninsured medical services. There is definitely a need. I’m a perfect example of it,” Arriola says.

The alliance hopes to start providing care this fall. Arriola plans to sign up. In the meantime, he prays that nothing serious happens. The way the system works now, he says, he’d have to experience a major calamity to get coverage.

“I would have to go into the hospital, I would have to lose my house, I will have to lose all my savings, lose everything for the government to be able to help me. So 40 years of work, 40 years of struggle has to come to nothing. I have to be totally destitute in order for me to be able to get some help.”

Arriola says he doesn’t want anybody to give him anything. He just wants to be able to afford health insurance.

“There has to be a way,” he says.
Source: NPR

For low cost high quality surgery abroad or discount medical services in the United States, call Healthbase at 1-617-418-3436.

Like it? Share it or save it!!

Peeking inside your doctor’s notes

healthbase — Thu, 01 Oct 2009 04:36:22 +0000

Almost all of us have been to the doctor at some point or the other in our lives. One of the common things you would have noted in your meetings with your doctor is him scribbling down notes. But, have you wondered what he writes in such notes? Do you think you should be allowed to see those notes? And, are you prepared to see what your doctor might have written about your meeting and your physiological and psychological conditions?

A lot of what’s in that note is objective stuff about your blood pressure, weight and blood count. But often your doctor puts down subjective impressions.

Did you seem down? Anxious? Angry? Drinking too much? Not so mentally sharp? Physicians also may speculate about a tentative diagnosis – maybe a scary one – they haven’t shared with you.

What do you think doctors would feel about letting patients see their notes? As you would guess, there are mixed opinions. Some feel comfortable while others don’t. It ranges from ‘Well, transparency is here, this will be good for patients, they’ll be more actively involved in their care, this is a terrific idea,‘ to ‘This is the worst thing I’ve ever heard of.‘

Doctors’ notes are not really secret anyway. Other doctors see them. Insurance companies and lawyers do. And under a 1996 federal law called the Health Insurance Portability and Accountability Act, or HIPAA, patients have every right to see their complete medical records. But as Dr. Tom Delbanco of Harvard Medical School (HMS) puts it, “You can get it but we do everything in the world to make sure you don’t get it. The medical record has traditionally been viewed by the medical establishment as something that they own. They think: ‘It’s my private notes. This is my stuff.’”

Check out below for some other kinds of opinions that different doctors share:

“Information should be accessible, but that will mean more work for doctors who may need to explain their notes to patients.”
“My hope is that it will be a method of communicating with patients, so patients can see what we’re thinking, where our head is, what our plans are, why we’re suggesting what we do.”
“We may be less candid. We may not as accurately describe the mood of the patient, the tenor of the encounter, for fear that we may get someone perhaps already a little angry during the encounter – more so after they log on and read the note that I just finished.”
“Physicians are scared of this kind of thing. But the big, broad directions are clear. Which is: Patients have to be at the center of their care more and more. That doesn’t mean patients call the shots. But patients really have to be a team member. To be a team member, they’ve got to see the playbook. And doctors will have to learn to be respectful in the way they write their notes in some situation.”
“If there’s some delicate problem, doctors shouldn’t dodge that topic, and patients should be prepared to see some things which may be a little painful for them to confront too.”

Your doctor’s reservations to this idea are understandable:

It will be more work for them, because patients will call up wanting to know what something means, or demanding corrections.
It might lead to more lawsuits.
It might scare the hell out of patients.

Source: Adapted from the NPR story – “Doctors Don’t Agree On Letting Patients See Notes” by Richard Knox

For affordable and quality medical care in the United States, check out domestic medical tourism. For surgery abroad, check out medical tourism.

Like it? Share it or save it!!

Medical Tourism Gets a Boost in the Philippines

healthbase — Fri, 25 Sep 2009 03:06:23 +0000

Like much of the world, the Philippine economy has seen a downturn in the last few years, with falling tourism revenue, poor investment prospects and a lack of overseas employment opportunities. Officials in the country are turning to medical tourism as a potential solution to some of their economic woes, however, and are hoping it will bring in new business, technology and interest in their country.

Over the past few years the Department of Tourism and the Department of Health have been working together to promote the Philippines as the hotspot among Asia’s myriad of medical tourism destinations. Drawing in these guests can be big business for a failing economy, as the government has estimated that the average visitor to the country for medical tourism spends around $3,500 during his or her stay. In hard times, those kinds of numbers and that kind of spending is hard to come by.

That reason, among others, is the driving force behind the medical summit that the Department of Tourism will be holding this October to discuss the future of medical tourism in Southeast Asia. Officials are hoping it will bring new interest to the growing field in the country and situate the Filipino care facilities as some of the best quality and highest value in the world.

While medical tourism in the Philippines has seen a growth in recent years, it still has some major issues and concerns from foreign visitors to address. The country has seen sanctions for the large number of poor Filipinos who sell organs like kidneys to wealthy Americans who are willing to pay for them. Part of the initiative of the summit is to change the image of the country and assure future patients that concerns like these are being resolved and the country doesn’t offer third-world health care but instead state of the art medical facilities.

Currently, the Philippines is home to many specialty facilities offering care from dental work to organ transplants, having some of the oldest heart, lung and kidney transplant centers in the region. Officials also want to promote the post-surgical care they can offer with health spas and wellness facilities springing up as well.

Of course, Filipino officials aren’t ignoring what is possibly the biggest draw for foreign visitors: low cost health care. In many cases, operations abroad cost a fraction of what they would at home, allowing those without insurance to get the health care they need without incurring life long debt.

This post was contributed by Hannah Watson, who writes about the online nursing program.

For cheap surgery in the Philippines, contact Healthbase.

Like it? Share it or save it!!

Medicare coverage for elderly Americans in Mexico: How feasible is it?

healthbase — Thu, 24 Sep 2009 04:15:00 +0000

The rising cost of health care in the United States is forcing an increasing number of U.S. citizens to turn their sights on Mexico for expert and cost-effective medical attention. But what about the health care for the elderly Americans who are already residing in Mexico? Should they be covered by Medicare in Mexico or should they have to fly back to America every time they need major medical care? Can the medical care providers in Mexico be trusted with the health of American seniors? Here’s an excellent read that recently appeared in a Mexican newspaper.

According to Paul Crist, the founder and president of Americans for Medicare for Mexico (AMMAC), a non-profit organization dedicated to bringing Medicare coverage to seniors living in Mexico, of the 800,000 American citizens living in Mexico approximately 200,000 are over 60 years old and thus are at or near eligibility for Medicare benefits.

Christ has lobbied 85 members of the U.S. Congress and prepared a 34-page proposal in which he outlines the pros of extending Medicare to Mexico. Medicare is now spending 6,700 dollars per year per beneficiary in the United States. For the same care in Mexico, Crist estimates that it will spend only 3,400 dollars, which translates to a very substantial saving.

Crist says that if Medicare is extended to Mexico, the program would only work with health care providers approved by JCI.

Although the health sector in Mexico is regulated and certified by the Mexican General Health Commission, the task of getting JCI certification for Mexico’s private hospitals is of prime importance.

One of the main reasons for pushing for certification is that the North American Free Trade Agreement or NAFTA obligates the Mexican medical system to be on a par with the United States and Canada, allowing for the free flow of patients from border to border and for fair trade, much like in other economic sectors.

But there is another huge reason for this interest in JCI certification and that is Medicare.

Crist revealed that ten hospitals in Mexico have JCI accreditation but another 23 are seeking approval. Among those already approved are the American British Padre Hospital and the Santa Fe Hospital in Mexico City and the Christus Muguerza Hospital and the Hospital Tec de Monterrey in Monterrey.

The approval of Medicare would greatly benefit hospitals such as Christus Muguerza, a Texas chain that now has seven hospitals under construction across Mexico. They have the advantage because their headquarters is in Texas, which gives Medicare a bit more confidence in the quality service they are going to provide.

In a recent interview with Forbes magazine, David Warner, a professor of health care policy at the University of Texas at Austin and a specialist on Medicare in Mexico, stated that an in-depth pilot project is needed to better understand the economics, determine whether Mexican heath care meets Medicare’s quality standards and determine if the payment system is sufficiently free of fraud.

According to Forbes, the U.S government is concerned that creating a Mexican medical exemption might be too complicated and costly to implement and would open the door for Americans in other countries.

Crist figures that if Medicare were accepted in Mexico, the 64 percent of American retirees currently flying back to the United States for expensive care would opt for treatment nearer their homes, cutting Medicare overall costs by a minimum of 22 percent.

Source: Guadalajara Reporter

For more information about quality health care services in Mexico and other countries at a major discounted price, log on to Healthbase and request a FREE quote for surgery.

Like it? Share it or save it!!

Federal Employees Health Benefits Program – a model for good insurance?

healthbase — Tue, 22 Sep 2009 08:45:00 +0000

An excellent story appeared yesterday on NPR that talked about the Federal Employees Health Benefits Program or FEHBP – the health insurance program that insures 8 million federal workers, retirees and their families, and members of Congress. Below is the story of a 13-year old daughter of a federal employee who feels blessed to have the FEHBP coverage to pay for the costs of managing her Type 1 diabetes. Do you think other insurance programs in the country should model themselves after FEHBP?

“This is what keeps me alive,” says 13-year-old Toni Bethea, as she picks a tiny glass bottle off the kitchen counter of her home in Washington, D.C. The clear liquid inside is insulin. Toni has Type 1 diabetes.

“Your health is obviously not anything that you should play around with,” says Toni, a high-school freshman. She’s pretty, smiling and stylish — from her bangs angled across her forehead to her sparkly red fingernails.

“You should take it very seriously and when you have a chronic illness like what I have and other kids have, it’s very important that we take care of ourselves because there’s a lot of preventable stuff that can happen to us.”

It helps that her mother, Rhonda Dorsey, has good insurance, which she gets as a federal employee. She’s covered by the Federal Employees Health Benefits Program, or FEHBP. It insures 8 million federal workers, retirees and their families — and members of Congress. That federal health insurance program has been held up — by the president, lawmakers and other players in the health care debate — as a model of the kind of good insurance that should be available to all Americans.

Dorsey and others who are covered under FEHBP do report high levels of satisfaction, but it’s not some kind of super insurance. It’s pretty much like most insurance people get through their jobs. Federal workers, too, sometimes complain about the rising costs of their premiums and co-payments and about the hassles of getting care.

The Option To Choose

Toni was five years old when she was first diagnosed with diabetes — as long as she can remember. “At five, I really didn’t know what was going on, but I remember having my mother and my grandfather holding me down to give me shots and prick my fingers. And I was scared, I was confused, and it wasn’t a good time.”

In those early, stressful days of her daughter’s illness, Rhonda belonged to a traditional HMO through FEHBP. She’d take Toni to see an endocrinologist, an eye doctor and one specialist after another. “I’d always have to get a referral. And sometimes I would forget and I’d get to the doctor’s office and it would be a mess. And so I’d be very apologetic and we’d have to call the pediatrician’s office, and it just was a waste of time in my opinion.”

There were limits, too, on the supplies she needed to manage Toni’s diabetes. Sometimes a prescription refill for needles or testing strips would be denied.

So Rhonda switched insurance companies. Her new plan allows her to keep taking her daughter back to the specialists who know her best. “I have the standard plan which means that I pay a little bit more up front,” she explains. “My deductible is a little bit higher, but I don’t have to deal with the referrals. I can go to any doctor.”

Federal employees get a lot of choice. That’s what makes the Federal Employees Health Benefits Program stand out compared to other insurance. In the Washington, D.C. area, there are at least 16 health plans to choose from. Across the nation, according to a new report by the Kaiser Family Foundation and the Health Research & Educational Trust, most companies offer only one health plan to their employees, and just one percent of companies offer three or more.

The federal Office of Personnel Management conducts annual negotiations with each health plan to set benefits and rates. That has allowed it to claim some success in constraining cost growth. But last year Blue Cross and Blue Shield — which covers about 60 percent of FEHBP enrollees — increased the premium for its standard option by 13 percent. As a result, the average for all federal plans went up 7 percent. The year before, the annual premium increase was just 2.1 percent.

Toni’s Life Depends On It

For Dorsey, an information specialist at the Nuclear Regulatory Commission, her insurance through FEHBP has been central to keeping Toni healthy. “In order to live a healthy life with Type 1 diabetes or any kind of chronic illness,” she says, “it’s so important to have good insurance. And I tell Toni all the time how blessed we are because we’ve met a lot of people who don’t have insurance at all.”

Still, even with good insurance, it’s expensive to manage diabetes. Toni pricks her calloused fingertips several times a day to check her blood sugar levels. Rhonda pays a little more than $200 a month for supplies.

Toni wears an insulin pump — it’s the size of a cell phone and it’s pink. “It had to be pink,” Toni says with a laugh. Adds her mother, “Pink is definitely her style.” The first pump cost $5,000. Insurance paid all but $500.

Toni knows she’s fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don’t have good health insurance. “At camp they provide you with supplies, but I’ve seen kids who have saved their needles and taken them with them,” she says. “Even though you weren’t like supposed to, they would kind of sneak them just to make sure they would have something when they got back home.”

Toni and Rhonda know that when people don’t have good insurance, they’re so desperate they will even reuse a needle. “It gets dull. And so it really hurts. But you have to have insulin, just like I said,” Rhonda says. “I mean, without insulin, Toni would die. So you, take the pain in order to live.”

Toni listens to her mother and adds, “I do feel very grateful for all that I have, because that could be me.”

Source: NPR, by Joseph Shapiro

For those without health insurance or poor health coverage, there is medical tourism (as well as domestic medical tourism) to help them afford the costs of major medical care. Read more about these on Healthbase.

Like it? Share it or save it!!

2009 survey shows family health premiums rose to $13,375 a year

healthbase — Fri, 18 Sep 2009 00:50:57 +0000

According to the 2009 Employer Health Benefits Survey, released on 15 September 2009 by the Kaiser Family Foundation and the Health Research & Educational Trust (HRET), premiums for employer-sponsored health insurance rose to $13,375 annually for family coverage this year – with employees on average paying $3,515 and employers paying $9,860.

The 2009 annual survey of employers provided a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information.

Following are some of the findings of the survey:

Family premiums rose about 5 percent this year. That’s much more than general inflation, which fell 0.7 percent, and workers wages that went up 3.1 percent, during the same period.
60 percent of firms offer health benefits to any of their workers this year. As in the past, the smaller the firm, the less likely it is to offer health benefits – with fewer than half (46 percent) of the smallest employers (three to nine workers) offering health benefits.
Among those firms offering benefits, 21 percent reported they reduced the scope of health benefits or increased cost sharing due to the economic downturn, and 15 percent reported they increased the worker’s share of the premium.
The survey reveals that a growing number of workers who are covered by their employer are facing high deductibles in their plans in addition to contributing to the premiums for their coverage. In 2009, 22 percent of covered workers must pay at least $1,000 out of pocket annually for single coverage before their plan generally will start to pay a share of their health care bills, up from 18 percent last year and 10 percent in 2006.
Preferred Provider Organizations (PPO) continue to dominate the employer market, enrolling six in 10 covered workers. Health Maintenance Organizations (HMO) cover 20 percent of workers, with an additional 10 percent in Point-of-Service plans, and 8 percent in consumer-directed plans, which are high-deductible plans that also include a tax-preferred savings options such as a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA).
Many businesses are struggling with ways to curb their health care costs, including offering high-deductible plans for workers, though relatively few (2 percent) expect to drop health benefits altogether.

Now in its 11th year, the survey is a joint project of the Kaiser Family Foundation and the Health Research & Educational Trust, an affiliate of the American Hospital Association. The survey, conducted between January and May, included 3,188 randomly selected, non-federal public and private firms with three or more employees.

Have you considered employer-sponsored medical tourism health benefits to cut down your costs but offer top quality health care benefits to your employees? Contact Healthbase for more information.

Like it? Share it or save it!!

blinklist blogmarks del.icio.us digg furl

Why Health Care Costs Keep Rising – Analysis and Solutions

healthbase — Wed, 16 Sep 2009 04:27:37 +0000

Why Health Care Costs Keep Rising – Analysis and Solutions

It’s no secret that the health care in the United States is expensive. But have you wondered why this is the case? Here’s an excellent analysis of the situation that we came across with proposed solutions of what can be done to cut down prices for the health care consumer – something which we feel you will find useful too. So, read on…

Summary

When economist Charles Wheelan published an analysis titled “The Top 10 Reasons for Soaring Health-Care Costs,” it was refreshing to read about the problem from an economics point of view. What Wheelan did not cover, however, was what we can do to address the issues that continue to cause health care costs to spiral out of control. What follows is a point-by-point look at Wheelan’s top 10 reasons followed by a discussion of what we are doing—or could do—to control costs better.

Analysis

Reason 1.
Nobody Shops for Value
Wheelan argues that when it comes to health care, everyone wants and expects the best. “There’s no medical equivalent of Wal-Mart,” he writes. “Everyone wants Neiman Marcus.”
Solution: Some health plans are addressing this issue by discouraging patients from using expensive facilities for common problems, such as a sore throat, through co-pay incentives and member education. Not only are patients encouraged to find a less expensive facility, they also are encouraged to ask the doctor to write generic prescriptions.
The question is, how do patients know which facilities offer reasonable prices and quality medical care? It will take greater health care cost and quality transparency—and better consumer education—to get health care shoppers to the same level of sophistication they use in buying other high-end goods (e.g., cars), but progress is being made. A number of health plans now offer cost information on various treatment options, and web sites such as HealthGrades offer quality information on doctors, making it possible for people to shop for health care online.

Reason 2.
Medical Innovations Are Usually More Expensive
The basis of medical progress is learning to do new things, no matter the cost. In the case of pharmaceuticals, the system has been designed so new drugs are expensive. Breakthrough medications receive patent protection, and the better the drug, the more its producer can charge. High prices yield high profits, which creates an incentive to develop the next generation of drugs.
Solution:Although we, as a society, have agreed to pay more for innovative medications and medical devices, especially those that introduce new cures, we have not agreed on who is going to pay for them. Part of the solution lies in the expansion of employer-sponsored wellness and health promotion programs that focus on keeping healthy people healthy and helping those who are sick to better manage their illnesses by steering them toward proven treatments. Value-based benefit plan design tries to achieve this by removing barriers that may be barring patient access to the most effective medications.
Furthermore, not all innovations (which include diagnostic tests, imaging tests, medications and medical devices) should be treated equally. While some add value, some do not. One solution is to use a creative plan design that identifies the most effective innovations and reimburses them with a premium.

Reason 3.
Some Health Care Is a ‘Luxury Good’
Used as a technical economic term, a “luxury good” is something wealthy people demand in disproportionately greater amounts than less wealthy people do. Richer societies and richer people within a society have higher expectations for health care. They expect medical fixes—such as hip replacements, stomach stapling and Lasik eye surgery—for problems that people with lower expectations will just tolerate.
Solution: While it’s easy to poke fun at medical tourism, it may well emerge as one of the solutions to this problem. Medical tourism generally involves traveling to another country for non-emergency care, including knee replacements, shoulder surgery and even heart bypasses. A knee or hip replacement that may have a retail price of $65,000 to $80,000 in the United States costs between $8,000 and $10,000 in India. The Deloitte Center for Health Solutions predicts that the number of Americans using medical tourism could jump tenfold over the next decade, to nearly 16 million a year.

Reason 4.
We Don’t Pay for What We Consume
Health care is unique in that neither the service provider nor the patient gets the bill, especially when insurance out-of-pocket maximum provisions are reached. The patient who is directly involved in the transaction has little incentive to control costs when out-of-pocket costs are removed. When insurance companies try to do so, it can lead to arbitrary limits on care, time-consuming hurdles for more expensive procedures and additional bureaucracy for doctors. Even then, it’s easy to game the system.
Solution:One possible solution is moving away from fee-for-service provider reimbursement and returning to a staff-model health maintenance organization (HMO), where providers employed by the health plans are charged with offering patients the most cost-efficient care without compromising quality. Two studies have found that this model works quite well. A 2002 paper in the British Medical Journal (BMJ), “Getting More for Their Dollar: A Comparison of the NHS with California’s Kaiser Permanente,” compared HMO provider Kaiser and Britain’s National Health System (NHS), concluding that Kaiser achieved better outcomes than the NHS for similar inputs. And a 2003 study in the BMJ, “Hospital Bed Utilization in the English NHS, Kaiser Permanente, and the US Medicare Program: Analysis of Routine Data,” which reported on hospital stay lengths, produced similar conclusions.
Over the past few years, several large employers have brought care delivery on-site in the form of clinics, using the same premise as the staff-model HMO. Revisiting global provider payments per admission or bundled payments for treating all the medical needs of specific patients with chronic disease might return to favor.

Reason 5.
Baumol’s ‘Disease’
Not a disease, but an important insight by economist William Baumol on what afflicts certain sectors of the economy, such as health care and higher education. He found that as societies become richer, labor-intensive endeavors, such as health care, become increasingly expensive relative to goods and services that can be produced using less labor. As long as the doctor-patient relationship remains relatively unchanged, health care costs will rise faster than prices in general.
Solution: Because there are no economies of scale, a surgeon cannot perform more than X number of surgeries and a primary care physician (PCP) cannot see more than X number of patients in a day (although we have seen the latter rise dramatically in the past two decades). For them to keep up with others, who are earning more money in less time because of technological advances, they have to increase their unit cost.
Pay-for-performance-type programs can help identify providers who are practicing quality medicine in the most judicious and cost-effective way. Once such high-quality and cost-efficient providers are identified, patients need to be directed to them. Specialized cancer and transplant centers are a good example of where upfront costs are relatively high but long-term outcomes are better and repeat illnesses are fewer.

Reasons 6 & 7.
Living Longer and Living an Unhealthy Lifestyle
Not only are people living longer (which in itself increases health care costs), but too many people are living unhealthy lives. This includes smoking, eating fast food and driving instead of walking, to name but a few.
Solution: While we can’t change the fact that people are living longer (nor would we want to), we can help them live healthier lives. The latest shift in health care is to focus on keeping the healthy healthy and to stop diseases from progressing from bad to worse. This can be achieved through wellness and health promotions, health education and coaching, communicating information on healthy lifestyle choices, and making sure those who need care have access to the right care at the right time to maximize clinical and economic value. People who are at risk or at high risk can be identified via health risk appraisals and sophisticated technology and tools, such as predictive modeling, which uses claims data to identify risk.

Reason 8.
The Uninsured
The uninsured end up costing the system a great deal of money. In a family that is uninsured, a child with a high fever and a bad cough will probably be treated in a hospital emergency room—a very expensive use of a trauma center and its highly trained staff. Or the child might not be treated at all until five years later when he or she develops asthma or another chronic condition that could have been managed far less expensively with better primary care.
Solution: This is a problem that needs government intervention. Although President Barack Obama has pledged to intervene, his health care program has yet to be addressed—specifically, how his programs will cover all Americans in the most cost-effective delivery setting.
One solution that plan sponsors can undertake in the meantime involves helping their pre-age-65 retirees with health insurance. They can take advantage of the innovative solutions that some health plans now offer—allowing employees to prefund premiums that contribute toward buying coverage after retirement but before they are eligible for Medicare.

Reason 9.
The High Cost of End-of-Life Care
Even people who are treated successfully for heart disease or cancer eventually die. Any medical success begets additional medical expense, which is especially true for end-of-life care. The last six months of life are typically the most expensive period of a person’s life.
The escalating cost of treating illness at the end of life raises moral and politically charged issues that are difficult to address: What is the actual value of using expensive treatments on people whose life expectancy is drastically limited, even with the treatment? While other countries have begun to base coverage decisions, in part, on how many years of quality life a treatment is expected to produce—for example, the clinical guidelines created by the U.K.’s National Institute for Clinical Excellence—this issue still seems to be taboo in the United States. Most of these costs are incurred by Medicare and Medicaid.
Solution: We need to be better at considering quality of life in decisions about treatments and services for chronically ill elderly patients. It has been suggested that Medicare and Medicaid could form a governing body of clinicians that can make and authorize these difficult decisions.
In addition, society needs to make better use of hospice care. Employers and plan sponsors should educate their beneficiaries about hospices and the situations in which they are the best option.

Reason 10.
Malpractice Suits
Malpractice is more of a legal problem than an economic one because doctors tend to practice “defensive medicine” out of fear of being sued. Seeking to avoid lawsuits, they have an incentive to over-treat all kinds of maladies. Research shows that physicians in countries such as the United States—where the risk of malpractice suits is high—tend to order more investigative tests than those in countries with less risk, such as the U.K. (See, for example, the New York Times article “Why Does U.S. Health Care Cost So Much?”)
Solution: Washington Post columnist George F. Will has proposed an appropriate solution to this complex issue. We have juries of people who have no knowledge of the complexities of medicine handling decisions on whether a patient’s death resulted from negligence on the part of the physician or whether the doctor did everything in his or her power to save the patient. Instead, the state judicial system could create a panel of highly qualified judges with access to independent clinicians who are familiar with the highly complicated nature of such cases and remove some of the emotional overreactions by juries that result in disproportional monetary awards that should be reserved for cases of gross negligence. This will help physicians use sound clinical judgment instead of practicing defensive medicine.

One More Reason: Lack of Access to Complete Information
Doctors collect and create a lot of information—everything from notes to diagnosis codes. The insurance companies add another level of data. While much of this information could be used to improve treatment and reduce costs, no one is in a position to see it all. A doctor who prescribes a treatment doesn’t know what it costs or whether the patient’s insurance covers it. An insurance company that questions a doctor about a treatment might never receive all of the information it needs. When a patient switches providers, it can result in duplicate tests and services and potentially dangerous treatments. All this creates tremendous administrative waste and resource consumption for providers and payers.
Solution: Electronic medical records (EMR) and health information exchange (HIE) are two steps in the right direction toward health care interoperability (the ability of different information technology systems and software applications to communicate; to exchange data accurately, effectively and consistently; and to use the information that has been exchanged). Developing standards for EMR interoperability is at the forefront of the president’s health care agenda. Many physicians have computerized practice management systems that can be used in conjunction with HIE, allowing them to share patient information (e.g.,lab results, public health reporting), which is necessary for timely, patient-centered and portable care.
Similar movement is happening on the payer side, which is attempting to collect more information from providers as well as consumers. They are making decision-support tools available to their beneficiaries, to help them navigate the system. Some payers are also adopting personal health records, which members can take with them if they change insurance providers.
Another step in the right direction is the patient-centric medical home model, in which a patient’s physician knows everything there is to know about that person’s health care. This requires comprehensive patient management software that allows the physician to coordinate all the care the patient needs.

Conclusion
The good news is, there are potential solutions to most of the reasons health care is so expensive. The real challenge is in getting the different stakeholders to work together to solve this monumental problem.

* Analysis by: GLG Expert Contributor
* Analysis of: Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth
* Published at: www.brookings.edu

Like it? Share it or save it!!

google ma.gnolia netscape reddit spurl

blinklist blogmarks del.icio.us digg furl

ROSE Procedure, a weight loss revision surgery

healthbase — Mon, 14 Sep 2009 04:06:48 +0000

ROSE Procedure, a weight loss revision surgery

Traditionally those who needed a revision bariatric surgery following a gastric bypass (also known as Roux-en-Y procedure) have had to resort to another open or laparoscopic gastric bypass surgery involving more cutting of the internals of the body. Such a revision obesity surgery is quite complicated and therefore surgeons and patients frequently avoided it for the high risks associated with it.

Today patients have a better choice which not only involves NOT opening up the patient, as it is done edoscopically, but is also less complicated and has minimal risks.

Need for the ROSE procedure

The ROSE procedure is a weight loss surgery (WLS), needed as a revision for a gastric bypass surgery. So let’s first understand what a gastric bypass procedure does.

The aim of a gastric bypass surgery is to make the stomach and stoma very small so that the stomach can now hold much less food and the feeling of satiety is achieved after the consumption of a very small amount of food. This makes the person eat less and thus lose weight.

Most people lose their excess weight to a great extent following a gastric bypass procedure. However, the stomach pouch and the stoma may expand/stretch over time causing the capacity of the stomach to increase. So the stomach can now hold more food and the feeling of fullness is now achieved after consumption of a larger amount of food than before. This results in weight regain.

A revision weight loss surgery is therefore required to once again reduce the size of the stomach pouch and the stoma. The ROSE (Restorative, Obesity Surgery, Endolumenal) procedure is a revision weight loss surgery for patients who have had gastric bypass surgery previously (at least 2 years ago) and lost 50% of excess weight but regained at least 15% of it back.

In a ROSE procedure, the surgeon pleats/folds the stomach with sutures to reduce its size back to about the size at the time of the original gastric bypass surgery. This is achieved through an endoscope (a long narrow tube carrying a camera and surgical instruments) which the surgeon inserts into the patient’s stomach pouch through a natural opening in his body, in this case his mouth and down the esophagus. The surgical tools in the endoscope are then used to gather together sections of stomach tissue to create a pleat which is then sutured together. With this process, the stomach volume and stoma diameter can be reduced to increase restriction and help weight loss. The procedure takes about an hour to complete.

Candidacy for the ROSE procedure

In order to be eligible for the ROSE surgery you must have:

had the gastric bypass procedure at least 2 years ago,
lost 50% of your excess body weight following the surgery, and
regained 15% of it back.

In some cases, a patient may also be a candidate if he underwent gastric bypass surgery but failed to lose weight.

Advantages of the ROSE procedure

Incisionless i.e. no external incisions or cuts therefore lower risk of infection and associated complications, and also no scarring
Quick procedure (takes about an hour)
Causes little or no discomfort to the patient
Minimal post operative pain/symptoms (mild sore throat, hoarseness, swollen lip, and lip pain due to the endoscopic instruments that were inserted into the mouth)
Fast recovery time

Cost of a ROSE procedure

For a FREE estimate of the cost of ROSE procedure in the United States or cost of ROSE procedure abroad visit Healthbase.

For more information about affordable surgery, read about international medical tourism and domestic medical tourism.

Like it? Share it or save it!!

google ma.gnolia netscape reddit spurl